Association of Neurocognitive and Physical Function With Gait Speed in Midlife | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Fritz  S, Lusardi  M.  White paper: “walking speed: the sixth vital sign.”  J Geriatr Phys Ther. 2009;32(2):46-49. doi:10.1519/00139143-200932020-00002PubMedGoogle ScholarCrossref
2.
Peel  NM, Kuys  SS, Klein  K.  Gait speed as a measure in geriatric assessment in clinical settings: a systematic review.  J Gerontol A Biol Sci Med Sci. 2013;68(1):39-46. doi:10.1093/gerona/gls174PubMedGoogle ScholarCrossref
3.
Bohannon  RW, Williams Andrews  A.  Normal walking speed: a descriptive meta-analysis.  Physiotherapy. 2011;97(3):182-189. doi:10.1016/j.physio.2010.12.004PubMedGoogle ScholarCrossref
4.
Peel  NM, Alapatt  LJ, Jones  LV, Hubbard  RE.  The association between gait speed and cognitive status in community-dwelling older people: a systematic review and meta-analysis.  J Gerontol A Biol Sci Med Sci. 2019;74(6):943-948. doi:10.1093/gerona/gly140PubMedGoogle ScholarCrossref
5.
Dumurgier  J, Elbaz  A, Ducimetière  P, Tavernier  B, Alpérovitch  A, Tzourio  C.  Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study.  BMJ. 2009;339:b4460. doi:10.1136/bmj.b4460PubMedGoogle ScholarCrossref
6.
Studenski  S, Perera  S, Patel  K,  et al.  Gait speed and survival in older adults.  JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923PubMedGoogle ScholarCrossref
7.
Demnitz  N, Hogan  DB, Dawes  H,  et al.  Cognition and mobility show a global association in middle- and late-adulthood: analyses from the Canadian Longitudinal Study on Aging.  Gait Posture. 2018;64:238-243. doi:10.1016/j.gaitpost.2018.06.116PubMedGoogle ScholarCrossref
8.
National Institute on Aging. Council minutes: May 2017, the 131st meeting, May 16–17, 2017. https://www.nia.nih.gov/about/naca/council-minutes-may-2017. Published 2017. Accessed May 20, 2019.
9.
Poulton  R, Moffitt  TE, Silva  PA.  The Dunedin Multidisciplinary Health and Development Study: overview of the first 40 years, with an eye to the future.  Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):679-693. doi:10.1007/s00127-015-1048-8PubMedGoogle ScholarCrossref
10.
The RAND Corporation. RAND 36-Item Short Form Survey (SF-36). https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html. Accessed August 14, 2019.
11.
Rantanen  T, Guralnik  JM, Foley  D,  et al.  Midlife hand grip strength as a predictor of old age disability.  JAMA. 1999;281(6):558-560. doi:10.1001/jama.281.6.558PubMedGoogle ScholarCrossref
12.
Mathiowetz  V, Kashman  N, Volland  G, Weber  K, Dowe  M, Rogers  S.  Grip and pinch strength: normative data for adults.  Arch Phys Med Rehabil. 1985;66(2):69-74.PubMedGoogle Scholar
13.
Bohannon  RW, Larkin  PA, Cook  AC, Gear  J, Singer  J.  Decrease in timed balance test scores with aging.  Phys Ther. 1984;64(7):1067-1070. doi:10.1093/ptj/64.7.1067PubMedGoogle ScholarCrossref
14.
Vereeck  L, Wuyts  F, Truijen  S, Van de Heyning  P.  Clinical assessment of balance: normative data, and gender and age effects.  Int J Audiol. 2008;47(2):67-75. doi:10.1080/14992020701689688PubMedGoogle ScholarCrossref
15.
Springer  BA, Marin  R, Cyhan  T, Roberts  H, Gill  NW.  Normative values for the unipedal stance test with eyes open and closed.  J Geriatr Phys Ther. 2007;30(1):8-15. doi:10.1519/00139143-200704000-00003PubMedGoogle ScholarCrossref
16.
Lezak  D, Howieson  D, Loring  D, Hannay  H, Fischer  J.  Neuropsychological Assessment. 4th ed. New York, NY: Oxford University Press; 2004.
17.
Jones  CJ, Rikli  RE, Beam  WC.  A 30-s chair-stand test as a measure of lower body strength in community-residing older adults.  Res Q Exerc Sport. 1999;70(2):113-119. doi:10.1080/02701367.1999.10608028PubMedGoogle ScholarCrossref
18.
Jones  CJ, Rikli  RE. Measuring functional fitness of older adults. https://www.dnbm.univr.it/documenti/OccorrenzaIns/matdid/matdid182478.pdf. Published 2002. Accessed August 31, 2019.
19.
Rikli  RE, Jones  CJ.  Functional fitness normative scores for community-residing older adults, ages 60-94.  J Aging Phys Act. 1999;7(2):162-181. doi:10.1123/japa.7.2.162Google ScholarCrossref
20.
Belsky  DW, Caspi  A, Houts  R,  et al.  Quantification of biological aging in young adults.  Proc Natl Acad Sci U S A. 2015;112(30):E4104-E4110. doi:10.1073/pnas.1506264112PubMedGoogle ScholarCrossref
21.
Wechsler  D.  Wechsler Adult Intelligence Scale. 4th ed. San Antonio, TX: Pearson Assessment; 2008.
22.
US War Department.  Army Individual Test Battery Manual and Directions for Scoring. Washington, DC: War Department, Adjutant General’s Office; 1944.
23.
Caspi  A, Houts  RM, Belsky  DW,  et al.  The p factor: one general psychopathology factor in the structure of psychiatric disorders?  Clin Psychol Sci. 2014;2(2):119-137. doi:10.1177/2167702613497473PubMedGoogle ScholarCrossref
24.
Wechsler  D.  Manual for the Wechsler Intelligence Scale for Children, Revised. New York, NY: Psychological Corp; 1974.
25.
Elley  W, Irving  J.  Revised socioeconomic index for New Zealand.  N Z J Educ Stud. 1976;11:25-36.Google Scholar
26.
Nofuji  Y, Shinkai  S, Taniguchi  Y,  et al.  Associations of walking speed, grip strength, and standing balance with total and cause-specific mortality in a general population of Japanese elders.  J Am Med Dir Assoc. 2016;17(2):184.e1-184.e7. doi:10.1016/j.jamda.2015.11.003PubMedGoogle ScholarCrossref
27.
Potvin  O, Dieumegarde  L, Duchesne  S; Alzheimer’s Disease Neuroimaging Initiative.  Normative morphometric data for cerebral cortical areas over the lifetime of the adult human brain.  Neuroimage. 2017;156:315-339. doi:10.1016/j.neuroimage.2017.05.019PubMedGoogle ScholarCrossref
28.
Habes  M, Erus  G, Toledo  JB,  et al.  White matter hyperintensities and imaging patterns of brain ageing in the general population.  Brain. 2016;139(4):1164-1179. doi:10.1093/brain/aww008PubMedGoogle ScholarCrossref
29.
Nadkarni  NK, Boudreau  RM, Studenski  SA,  et al.  Slow gait, white matter characteristics, and prior 10-year interleukin-6 levels in older adults.  Neurology. 2016;87(19):1993-1999. doi:10.1212/WNL.0000000000003304PubMedGoogle ScholarCrossref
30.
Ezzati  A, Katz  MJ, Lipton  ML, Lipton  RB, Verghese  J.  The association of brain structure with gait velocity in older adults: a quantitative volumetric analysis of brain MRI.  Neuroradiology. 2015;57(8):851-861. doi:10.1007/s00234-015-1536-2PubMedGoogle ScholarCrossref
31.
Kilgour  AH, Todd  OM, Starr  JM.  A systematic review of the evidence that brain structure is related to muscle structure and their relationship to brain and muscle function in humans over the lifecourse.  BMC Geriatr. 2014;14:85. doi:10.1186/1471-2318-14-85PubMedGoogle ScholarCrossref
32.
Rosso  AL, Verghese  J, Metti  AL,  et al.  Slowing gait and risk for cognitive impairment: the hippocampus as a shared neural substrate.  Neurology. 2017;89(4):336-342. doi:10.1212/WNL.0000000000004153PubMedGoogle ScholarCrossref
33.
Tian  Q, Resnick  SM, Davatzikos  C,  et al.  A prospective study of focal brain atrophy, mobility and fitness.  J Intern Med. 2019;286(1):88-100.PubMedGoogle ScholarCrossref
34.
Montero-Odasso  M, Almeida  QJ, Bherer  L,  et al; Canadian Gait and Cognition Network.  Consensus on shared measures of mobility and cognition: from the Canadian Consortium on Neurodegeneration in Aging (CCNA).  J Gerontol A Biol Sci Med Sci. 2019;74(6):897-909. doi:10.1093/gerona/gly148PubMedGoogle ScholarCrossref
35.
Deary  IJ.  Looking for “system integrity” in cognitive epidemiology.  Gerontology. 2012;58(6):545-553. doi:10.1159/000341157PubMedGoogle ScholarCrossref
36.
Arden  R, Gottfredson  LS, Miller  G.  Does a fitness factor contribute to the association between intelligence and health outcomes? evidence from medical abnormality counts among 3654 US Veterans.  Intelligence. 2009;37:581-591. doi:10.1016/j.intell.2009.03.008Google ScholarCrossref
37.
Dubal  DB, Yokoyama  JS, Zhu  L,  et al.  Life extension factor klotho enhances cognition.  Cell Rep. 2014;7(4):1065-1076. doi:10.1016/j.celrep.2014.03.076PubMedGoogle ScholarCrossref
38.
Redman  LM, Smith  SR, Burton  JH, Martin  CK, Il’yasova  D, Ravussin  E.  Metabolic slowing and reduced oxidative damage with sustained caloric restriction support the rate of living and oxidative damage theories of aging.  Cell Metab. 2018;27(4):805-815.e4. doi:10.1016/j.cmet.2018.02.019PubMedGoogle ScholarCrossref
39.
Barzilai  N, Crandall  JP, Kritchevsky  SB, Espeland  MA.  Metformin as a tool to target aging.  Cell Metab. 2016;23(6):1060-1065. doi:10.1016/j.cmet.2016.05.011PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Putting Humpty-Dumpty Together
    Thomas Caffrey, Ph.D., Clinical Psychology | Private practice, Forensic Psychology
    This fascinating study goes a long way to mend our continued tendency to bifurcate the mental and physical in the person. As a lifelong "speed-walker," or, now, "power-walker," I was consoled by the finding that fast walking tends to reflect good CNS health and less overall cognitive decline, as well as good physical condition. It was also consoling, from a philosophical point of view, to see hard evidence for the strong link between the apparently "merely physical" gait speed and the cognitive features cited.
    CONFLICT OF INTEREST: None Reported
    Original Investigation
    Neurology
    October 11, 2019

    Association of Neurocognitive and Physical Function With Gait Speed in Midlife

    Author Affiliations
    • 1Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
    • 2Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
    • 3Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
    • 4Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
    • 5Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
    • 6Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
    • 7Department of Oral Sciences, University of Otago, Dunedin, New Zealand
    • 8Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
    • 9Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    • 10Department of Medicine, Duke University, Durham, North Carolina
    • 11Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
    • 12Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina
    • 13Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
    JAMA Netw Open. 2019;2(10):e1913123. doi:10.1001/jamanetworkopen.2019.13123
    Key Points español 中文 (chinese)

    Question  Is gait speed measured at age 45 years associated with accelerated biological aging, neurocognitive function, and cognitive decline?

    Findings  In this 5-decade cohort study of 904 participants in New Zealand, physical and biological indicators of accelerated aging, including compromised brain integrity (eg, reduced brain volume and cortical thickness), were associated with slow gait measured at age 45 years. Lifelong compromised brain health—including poor neurocognitive functioning as early as age 3 years and childhood-to-adulthood decline in cognitive functioning—was associated with slower gait at midlife.

    Meaning  Gait speed at midlife may be a summary index of lifelong aging with possible origins in childhood central nervous system deficits.

    Abstract

    Importance  Gait speed is a well-known indicator of risk of functional decline and mortality in older adults, but little is known about the factors associated with gait speed earlier in life.

    Objectives  To test the hypothesis that slow gait speed reflects accelerated biological aging at midlife, as well as poor neurocognitive functioning in childhood and cognitive decline from childhood to midlife.

    Design, Setting, and Participants  This cohort study uses data from the Dunedin Multidisciplinary Health and Development Study, a population-based study of a representative 1972 to 1973 birth cohort in New Zealand that observed participants to age 45 years (until April 2019). Data analysis was performed from April to June 2019.

    Exposures  Childhood neurocognitive functions and accelerated aging, brain structure, and concurrent physical and cognitive functions in adulthood.

    Main Outcomes and Measures  Gait speed at age 45 years, measured under 3 walking conditions: usual, dual task, and maximum gait speeds.

    Results  Of the 1037 original participants (91% of eligible births; 535 [51.6%] male), 997 were alive at age 45 years, of whom 904 (90.7%) had gait speed measured (455 [50.3%] male; 93% white). The mean (SD) gait speeds were 1.30 (0.17) m/s for usual gait, 1.16 (0.23) m/s for dual task gait, and 1.99 (0.29) m/s for maximum gait. Adults with more physical limitations (standardized regression coefficient [β], −0.27; 95% CI, −0.34 to −0.21; P < .001), poorer physical functions (ie, weak grip strength [β, 0.36; 95% CI, 0.25 to 0.46], poor balance [β, 0.28; 95% CI, 0.21 to 0.34], poor visual-motor coordination [β, 0.24; 95% CI, 0.17 to 0.30], and poor performance on the chair-stand [β, 0.34; 95% CI, 0.27 to 0.40] or 2-minute step tests [β, 0.33; 95% CI, 0.27 to 0.39]; all P < .001), accelerated biological aging across multiple organ systems (β, −0.33; 95% CI, −0.40 to −0.27; P < .001), older facial appearance (β, −0.25; 95% CI, −0.31 to −0.18; P < .001), smaller brain volume (β, 0.15; 95% CI, 0.06 to 0.23; P < .001), more cortical thinning (β, 0.09; 95% CI, 0.02 to 0.16; P = .01), smaller cortical surface area (β, 0.13; 95% CI, 0.04 to 0.21; P = .003), and more white matter hyperintensities (β, −0.09; 95% CI, −0.15 to −0.02; P = .01) had slower gait speed. Participants with lower IQ in midlife (β, 0.38; 95% CI, 0.32 to 0.44; P < .001) and participants who exhibited cognitive decline from childhood to adulthood (β, 0.10; 95% CI, 0.04 to 0.17; P < .001) had slower gait at age 45 years. Those with poor neurocognitive functioning as early as age 3 years had slower gait in midlife (β, 0.26; 95% CI, 0.20 to 0.32; P < .001).

    Conclusions and Relevance  Adults’ gait speed is associated with more than geriatric functional status; it is also associated with midlife aging and lifelong brain health.

    ×